Osteogenesis in Multiple Myeloma

It has been generally accepted that untreated, uncomplicated myeloma does not usually produce periosteal reaction (1–3). There have been, however, a few scattered reports in the literature of myeloma associated with osteogenesis. Krainin, D'Angio, and Smelin (4) in 1949 reported the case of a sixty-eight-year-old female with multiple myeloma with extensive new bone formation involving the humerus, accompanied by a fracture in one portion of the shaft. A more recent example (1958) is recorded by Lewin and Stein (5), whose patient was a forty-eight-year-old male with solitary spinal involvement showing new bone formation. Certainly osteogenesis is only rarely encountered in multiple myeloma. The purpose of this paper is to add one report to the meager list of such cases. A 67-year-old white woman entered the hospital because of swelling of the left mandible, left cheek, and left forehead of two months duration. She had recently undergone tooth extraction and swelling had persisted after removal of the tooth. The past history' and system review were not contributory. On physical examination, moderate swelling over the anterior portion of the left mandible, as well as around the left eye, was obvious. Some irregularities of the calvarium could be felt. No particular tenderness was noted in the involved areas. Roentgen examination demonstrated multiple discrete areas of bone destruction involving the skull (Figs. 1 and 2). There were, however, areas of periosteal new bone formation along the ramus of the left mandible and particularly in the left frontal bone at the site of a large osteolytic defect (Fig. 3). Because of the osteogenic activity, a diagnosis of metastatic sarcoma of undetermined type was entertained. Shortly thereafter a biopsy of the left mandible was carried out and the report of the pathologist included the following statements: “The tumor is composed of undifferentiated, closely packed cells with moderately hyperchromatic nuclei. The amount of cytoplasm varies considerably. Little or no cytoplasm is found in the more compact areas of the tumor. Rather marked osteoblastic activity in many parts of the bony fragments is present. In some places there is heaping of many layers of osteoblasts. There is evidence of new bone formation. There are no areas of poorly formed osteoid tissue or poorly formed cartilaginous tissue such as is frequently seen in osteogenic sarcoma.” A diagnosis of malignant tumor, probably of mesenchymal origin, was made. Following this, the patient was referred elsewhere. Additional studies included sternal marrow puncture, which revealed large numbers of myeloma cells, and paper electrophoresis showing abnormal globulin beyond the range of gamma globulin, which was interpreted as abnormal myeloma globulin.